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Evidence-based medicine: What’s not to like? by Sandy Gottstein

Evidence-based medicine is the big thing these days. Although this is certainly a step in the right direction, I can’t help but wonder what took so long? Regardless, the good news is that apparently there is now a more concerted effort to base medicine on evidence. The bad news is that it is an implicit recognition that medicine was not particularly “evidence-based” in the past.

But is medicine really evidence-based now?

It all depends on the evidence. Who is paying for it? Who is influencing, if not directly paying for, it and how is it being influenced? What gets published in journals heavily financed by drug company advertising? How does conflict of interest of those “peers” doing the reviewing affect what gets published? How does ridicule of new ideas and/or the people thinking them affect the questions being asked?

I’m all for evidence-based medicine. Who wouldn’t be?

But we shouldn’t kid ourselves that all evidence is equal. Calling research “evidence-based” in and of itself does not make a study reliable and valid. “Evidence” derived from industry sponsored/influenced studies, disclosed or not, simply cannot be accepted at face value.

Research financed by someone or something that stands to benefit financially from the results of that research has no credibility and cannot be assumed to be trustworthy. Period. No matter where it is published. No matter who the authors are. No matter how much of it there might be.

A million times zero is still zero.

As I said, I’m all for evidence-based medicine. Who wouldn’t be? But all evidence is not equal. We ought not to ignore that fact. And do so at our own peril.

"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."

-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820

“A sacred cow will not protect the herd.”

-- Sandy Gottstein

"What's the point of vaccination if it doesn't protect you from the unvaccinated?"

-- Sandy Gottstein

"Who gets to decide what the greater good is and how many will be sacrificed to it?"